BrookeArmyMedicalCenter Sports Medicine

Outpatient Rehabilitation Protocol
Shoulder Arthroscopy

(Includes: Sub-acromial decompression, arthroscopic or open distal clavicle resection, Type I & III SLAP tear debridement, etc…)

INPATIENT: Post-operative day (POD) 1 through 1st PT appointment

PT Sessions: Afternoon visit after surgery and daily supervised sessions

Sling:Shoulder immobilizer or sling

1.Wear as needed for comfort

  1. Remove 3x/day for PT exercises, and for personal hygiene

Exercises:

  1. Grip Strength w/ foam ball, towel, putty to squeeze repetitively
  2. Hand, wrist, elbow full active range-of-motion (AROM)
  3. Shoulder passive pendulum exercises
  4. Assisted passive range-of-motion (PROM) of shoulder to tolerance
  5. Pt indep with cryotherapy use at least 3 x day for home
PHASE I: Hospital d/c through Week 6 – EARLY STRENGTHENING & ENDURANCE

PT Sessions: 2-3 supervised sessions per week with physical therapist

Sling:d/c sling as tolerated

Exercises:

  1. Grip Strength w/ foam ball, towel, putty to squeeze repetitively
  2. Hand, wrist, elbow full AROM w/ light weights (1-3 lbs.; incr. prn)
  3. Modified passive pendulum exercises
  4. Supine assisted PROM shoulder to maximum limits; include wand/stick, pulley, wall climbs, assistance from opposite UE, etc…

DO NOT PUSH THROUGH ANY SHARP OR STABBING PAIN

  1. AAROM/AROM to maximum tolerance
  2. Scapular retraction and protraction (pinch/spread shoulder blades)
  3. Cross chest (posterior capsule) stretch (avoid ACJ or impingement pain)
  4. ADL’s as tolerated at from waist to shoulder height; NO overhead motion

Aerobic Conditioning:

  1. Stationary bike, elliptical trainer, stairmaster
  2. May walk on treadmill; Light jogging if pain free on treadmill
  3. Upper body cycle up to 5 min forward and 5 min backward
PHASE II: Week 6 - 12 – ADVANCED STRENGTHENING & ENDURANCE

PT Sessions: 1-2 supervised sessions per week with physical therapist

Exercises:

  1. Continue all previous exercises
  2. Address all residual strength and ROM impairments
  3. Capsular stretches as needed (emphasize posterior capsule)
  4. Progressive resistance exercises for shoulder girdle complex
  5. Full ADL’s prn with no lifting > 20 lbs.
  6. Start with wall push-ups; progress to push-ups on table, then to knees
  7. Basic aquatic (pool) therapy if available
  8. Functional / job-specific training exercises

Aerobic Conditioning:

  1. May jog or run on treadmill as long as shoulder is PAIN FREE
  2. Upper body cycle up to 10-15 min forward and 10-15 min backward

Criteria for Progression to PHASE III:

  1. Full shoulder AROM
  2. Full strength per manual or isokinetic muscle testing
  3. Pain-free ADL’s and functional training exercises
PHASE IV: Week 12 – 24 (6 months) – RETURN TO FULL DUTY

Communicate closely with Ortho if ROM goals have not been met

When rehabilitation goals are met:

  1. Full shoulder AROM
  2. Full strength per manual and isokinetic testing
  3. Able to pass APFT, including push-ups

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JAMES R. FICKE, MDKATHLEEN S. ZURAWEL, PT, OCS

COL, MCCOL, SP

Chief, OrthopedicsChief, Physical Therapy

APPROVE / DISAPPROVEAPPROVE / DISAPPROVE

Updated 25 October, 2006